title: Quality and consistency of clinical practice guidelines for the management of children on chronic dialysis.
abstract: BACKGROUND
  Clinical practice guidelines aim to improve the quality of care, yet for users of guidelines it is often not clear how these guidelines were developed and whether the recommendations are robust. We aimed to identify all current published guidelines for the management of children on chronic dialysis, assess the quality of their development and evaluate consistency among their recommendations.
  
  
  METHODS
  We searched Medline (1948 to January 2012), and relevant websites of guideline development programmes. Three reviewers appraised all 17 identified guidelines with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument.
  
  
  RESULTS
  The guidelines were developed by five different professional associations. The overall mean AGREE II score from seven Kidney Disease Outcomes Quality Initiatives (KDOQI) guidelines was considered sufficient (mean scores 64-75%), and from all other 10 guidelines poor (29-44%). Five out of seven KDOQI guidelines scored weak on applicability. We found important inconsistencies between recommendations concerning initiation of renal replacement therapy, management of haemoglobin level and the use of mupirocin to prevent exit-site infections.
  
  
  CONCLUSIONS
  While the recently developed KDOQI guidelines meet the modern quality standards, advice for implementation of these recommendations is lacking. There is an urgent need for international collaboration and coordination to ensure that the management of children on chronic dialysis is informed by relevant and high-quality evidence.
authors.affiliation: Department of Paediatric Nephrology, Emma Children's Hospital AMC, Amsterdam, The Netherlands.
authors.forename: Nikki J
authors.initials: NJ
authors.lastname: Schoenmaker
authors.forename: Wilma F
authors.initials: WF
authors.lastname: Tromp
authors.forename: Johanna H
authors.initials: JH
authors.lastname: van der Lee
authors.forename: Martin
authors.initials: M
authors.lastname: Offringa
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.forename: Jaap W
authors.initials: JW
authors.lastname: Groothoff
mesh_terms: D002648:Child; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D016730:Program Development; D011786:Quality Control; D011787:Quality of Health Care; D006435:Renal Dialysis
keywords: dialysis; end-stage kidney disease; guidelines; paediatric nephrology; systematic review